For a recent panel discussion on what it means to be a leader of digital change, HTN was joined by digital leaders from the health sector, including Julia Lake, associate director for digital (data) at Leeds Teaching Hospitals; Penny Kechagioglou, senior clinical oncology consultant, CCIO, and deputy chief medical officer at University Hospitals Coventry and Warwickshire NHS Trust; and Sally Mole, senior digital programme manager – digital portfolio delivery team at The Dudley Group.
The panel touched upon different aspects of digital leadership, including what being a leader of digital change looks like for them, culture, overcoming challenges, change management, the role of a digital leader now and in the future, and how to balance priorities in the short- and long-term.
Julia kicked us off with the introductions, sharing how her journey into the health sector had started “by accident”, after finishing university. After working “between finance and data” at a hospital in Macclesfield, she told us how her interest in digital healthcare was piqued, and that she’s been at Leeds Teaching Hospitals ever since. “I was just so interested in how technology could help people and processes make a difference,” she said.
Sharing her own journey into the broader health field and then into digital leadership, Penny told us about her role as a consultant in the NHS and her work as an oncologist. “I’ve always had an interest in the healthcare management space as well,” she went on, “and I’ve had various leadership roles over the last few years, both with the NHS and in the private sector.” What drew her to digital specifically was the challenge, she said, “because I’d never been tech savvy, and I wanted to understand how digital could help us innovate and improve services. I’m also very interested in leadership and bringing people together, and in how we can achieve the best outcomes for patients – I think digital is a huge enabler.”
Sally talked about her 24 years of history of working in pharmacy, and how working in the discharge areas of a hospital meant she could “see the problems staff were having on the floor” and motivated her to look at how they could be solved. “I knew that at that level I couldn’t make the impact and the change I wanted to make,” she said, “and then when a role in digital came up, I took a side step in that direction to join The Dudley Group, starting in the configuration team building the EPR, and I loved it, because I could see the difference we were making.”
What does digital leadership look like?
“Digital leadership isn’t so different from other types of leadership,” Julia considered, “but there’s a lot of work to be done around engagement and leveraging digital tools and data.” Providing the right vision, the right environment, and the right culture are also key factors to success with digital leadership in particular, she went on, “to make sure you’ve got acceptance of those technologies, and you’ve got the right people in place to do that”.
Challenges specific to digital leadership include “the fast pace of digital and innovation”, Julia said. Giving the example of when her team started looking into cloud, she told us about how they had been overwhelmed by the different technologies and the pace with which everything was moving, adding “often it’s the skillset required to deliver the pace of change, and so a big part of it is getting the right people who can keep up with that change – that’s been one of the biggest challenges – finding a data architect, for example, has been tricky.” To get around that, the trust started focusing on developing their own talent, as well as looking to university graduates, “not always going for skillset, but going for attitudes and aptitudes”, she shared.
Penny agreed with all of Julia’s points, before adding that digital leadership is also about “understanding where digital falls within an organisation – it should be one of the biggest enablers, and it’s important that the strategic direction of the organisation involves digital in every aspect”. Sometimes digital can be seen as “something that is separate”, according to Penny, “and it’s how we bring all of that capability of IT colleagues, analysts, architects, into the clinical space and get everyone working as a team”.
Stating that this challenge of getting people working together was one that she had experienced in her time as a digital leader, Penny said that “sometimes the day-to-day operational pressures take precedence, and we’re always quite reactive in trying to do things, but we need to take a step back and look at how digital can help us achieve those efficiencies and service pathway developments.” Giving the example of University Hospital’s Coventry and Warwickshire’s EPR programme, she talked about how the organisation is “learning how digital clinical teams can be blended within the rest of the teams in the organisation and the structure of the organisation, so everyone benefits”.
If we want to develop the digital leaders of the future, Penny continued, “we need to allow that space and time for people to be involved more in digital, which opens up doors for staff development and for promotion”. Often when digital change is happening, the workforce can be left behind, she observed, “and those two need to come together – more specialised posts will be needed in future to maintain all of these things into the future and ensure we get the benefit out of those digital tools”.
“It’s about the communication – it’s important to take everybody on the journey with you,” said Sally, “and ascertaining what you can and can’t do, what the challenges are, what the limitations are. It’s also ensuring the organisation is ready, looking at the governance processes to make sure everything we’re doing is done in a safe and appropriate manner.” Whilst sometimes that can be at a board level, looking at aligning strategy and objectives; it’s also about those on the frontline and the patients who are going to be impacted by the changes being made, she went on.
“As a leader it’s how we pull all of that together, and making sure we’ve got the right teams doing the right jobs to help get that buy-in,” Sally shared, “and one of the biggest challenges I’ve come across personally is managing the resource versus the demand – once you start going live with digital solutions, and people start to realise the benefits, we have a big influx of requests for different projects and things people want.” The team is limited, she said, by the resources available, and “can’t always do the things that aren’t going to have a big value impact”.
Sally highlighted: “Funding is difficult to come by – sometimes even when you are offered the funding and you need to match capital or revenue; sometimes you can’t take it because you can’t physically carry on with the ongoing revenue.”
Managing change and overcoming resistance to change
When it comes to managing change and overcoming resistance to change, Julia talked about the importance of “breaking down some of the siloes and empowering people”, whilst “not using technology for technology’s sake”. When approaching digital change, she also noted the risks associated with simply placing technology on top of “a really poor process”, because that can prevent any potential benefits from being realised.
Being transparent and demonstrating the benefits and the value of a digital solution is key to overcoming any resistance to change, Julia told us, “particularly if you can tie that in with better patient outcomes and patient care”. A lot of that work is about “demystifying” technology, she said, “because the talk about acronyms and tech stacks can go over some people’s heads, and taking it back to basics with what it will actually do and what it will mean to people’s everyday roles helps them relate it back to themselves.” That is when people start looking at ways of innovating, and “seeing technology as something that can help them, rather than as a hinderance,” she finished.
Sally talked about needing to look in two directions – at the requests coming from board level, and those coming from people on the shop floor. “At Dudley we’ve got one front door where all of that comes in”, she said, “and no matter which direction something comes in from, we make sure we’ve constantly got that ongoing engagement so that everybody knows where we are and what’s happening.”
Getting clinical buy-in can be difficult, Sally said, “and we need that in order to deploy something safely”. Although her team do hold engagement sessions and undertake work around that engagement, “sometimes that isn’t enough, because they don’t have the time to give up for that”, she added. Working in digital in the health sector requires flexibility around clinical staff and their time, she reflected, “due to the pressures they’re under to deliver their clinical services, as well as the things we’re asking them to implement – it’s about being there, supporting them through it, and helping them understand the benefits to them, their patients, and the organisation.”
Another point Sally picked up on was the follow-up to digital projects, and the failure to celebrate “some of that really hard work we put in to making those changes”. Whilst something might be integrated really well, and people might be doing a good job of using or implementing something, “we don’t go back and do that piece of celebratory work, and we don’t go back to ask how it’s going, or to tell people how they’re performing” she said. “That’s really important, because there have been huge pieces of work that have been done, which have made a huge difference, and the people that are doing that are the frontline staff. If you build those relationships with staff, I think you just will get better engagement.”
Reflecting back on her experience during the pandemic, Penny said: “What we learned back then, was that leadership was the catalyst to bringing an idea to implementation, and how to bring stakeholders on board, because there was crisis.” Having to get through that difficult period “in a different way to the ways we were used to” meant that digital became more established, she said, “and we should not lose sight of that”.
Strategy is one thing, according to Penny, “but we don’t always prepare well for implementation; that was one of the things I made sure we did during our EPR implementation, that we had a very good plan and people who were passionate about it before we began the implementation”. Staff were given time within their working week to get involved with the project, she continued, “and I think distributing leadership down to the teams who actually know what they need to change and why, is part of the project’s success”.
Adoption overall has been good, Penny said, “but there are those pockets of resistance, as there always are, and the key to that I would say is to roll with it – the people who are resisting are actually the ones who may have a good idea on the way we can do things”. Going into that conversation with that mindset, rather than condemning it, “actually brings those who resist in”, she said, “and understanding what those issues are can inform improvement”. Digital change can help bring processes to the forefront “which may not work but we didn’t know”, she considered, “and we need to go into that improvement with an open mindset, seeing it as an opportunity to make things work”.
Planning for digital change
Sally shared some of the steps that her team take at The Dudley Group to plan for digital change, and some of the touchpoints they use to look for potential clinical risk. “We use things like user acceptance testing”, she said, “where we ask for our users’ thoughts on the new future processes and their thoughts on clinical safety. We then move to a more formal part of the process, clinical acceptance testing, where we ask them to immerse themselves in their clinical role and see whether something actually fits within patient scenarios within their journey. We’re looking to our clinical staff to point out clinical risks, and because we haven’t had formal sign-off yet, we can still make those changes.”
The clinical safety aspects and any clinical risks picked up during this process, along with a clinical safety panel including divisional leads from across the trust, “should inform the end design”, Sally told us, “with an output that the end solution should be clinically safe”. Doing plenty of upfront planning and “putting contingency in your plans” is essential, she said, “because you’ll always find something you didn’t expect; and that’s how you get a successful project in the end”.
Reflections and outlook on digital leadership
Considering any advice for those looking to get into digital leadership, and reflecting back on things it might have been useful to know at the beginning of her own journey, Julia said that her main piece of advice is to “always walk the shop floor and know your people”. Horizon scanning and remaining open to new ideas are also important elements, she went on, “and for a digital leader especially, you have to have that open mind and bring people on that journey, as well as be ready to admit what you don’t know”. In general, her advice is to “always be yourself, and be comfortable in your own skin as a leader”. She also talked about the “really wonderful network of digital advocates” in Leeds, “which consists of operational staff, nurses, clinicians – using that support will help you drive your agenda”.
One of the challenges is managing competing priorities, Julia shared, “and I’ve got five different teams, so that’s always an issue for me”. Ring-fencing some resources to do “the forward-looking things” is important, she continued, telling us about her current work in moving the organisation’s data from a data warehouse to the cloud, and how that involved meeting requirements set by NHS England, alongside “internal ad-hoc, statutory and clinical audit stuff that needs to be done”. At Leeds, she shared, one of her teams are specifically focused on the future, “looking at what’s coming next, we’ve got the new hospital build, tech changes, and lots of innovative things happening – keeping an eye on the future and provisioning for that will be essential for us”.
“I love all of Julia’s points,” said Penny, “but I’d add one word: credibility. What I found was that I thought I knew the organisation I was working in, until I became CCIO, and then I discovered a whole new cohort of people I’d never met, and a whole different side of the organisation.” Being visible, listening to the challenges, and asking the right questions is key, she went on, “and it’s about bringing diverse people together to create change, transformation; it’s never a process that happens in siloes”. As a digital leader specifically, it’s also about having the right skillset, and balancing your digital team with the vendors and delivery partners who may be involved, she added, “so there’s definitely that commercial element there too”.
“The only thing I’d add is not to be afraid to challenge the current status quo,” Sally told us, “so not only keeping that conversation going, but asking why we do things in certain ways – just because that’s the way things have always been done, doesn’t mean it’s the right way, and sometimes we forget to challenge that.” Understanding how people have got to where they are, and how digital can make that better for them, is key, she said.
We’d like to thank all of our panellists for joining us and sharing their insights on this topic.
